Identification and Characterization of Reverse Triggering in Acute Hypoxemic Respiratory Failure Using an Automated Tool

BACKGROUND: Reverse triggering is a highly common ventilatory asynchrony in sedated critically ill patients. When accompanied by high respiratory effort, it may cause diaphragmatic and lung injury. However, assessing its incidence and the associated effort remains limited, as it relies on expert review of waveform segments representing <5% of the full recording. Automated methods to assess and better characterize this patient-ventilator interaction are needed. METHODS: yCharm Community Edition 2025.1.3) to identify the prevalence of reverse triggering and characterize reverse triggering in terms of the magnitude of respiratory effort and temporal trends over ∼12-h recordings. The tool was validated against expert visual assessment. RESULTS: O. CONCLUSIONS: An automated tool using flow and airway pressure accurately detected reverse triggering during prolonged recordings. Reverse triggering was frequent and typically associated with low respiratory effort, with marked variability across patients.